I think most hospitals are having the same experience.
MH: Has the Medicaid expansion had an impact on the broader state economy?
Beshear: Before I made the decision to expand Medicaid in our state, I asked PricewaterhouseCoopers and the University of Louisville to do an economic study of the impact. They came back in about six months and said, “Governor, you really can't afford not to do this. By expanding Medicaid, you're going to infuse about $15 billion into your economy over the next eight years, you're going to create 17,000 new jobs over the next eight years, and it will have a positive impact on your budget.” Based on that study, I made the decision. In the next three or four months, we're going to update that study and see where we are today.
From July 2013 to July 2014, Kentucky has seen an additional 3,000 jobs created in core healthcare services, along with almost 8,000 additional jobs in administrative and support services. So the jobs part seems to be working the way that study indicated. I feel very confident that by the time Kentucky has to start picking up a small share of the expanded Medicaid program in 2017, we will be able to afford it and keep the program in place.
MH: Are you experimenting with new payment models in Medicaid, such as payment for value and payment for outcomes?
Beshear: About three years ago we took almost our entire Medicaid program to the managed-care model because I felt very strongly that it was time to pay for results and not just for the number of procedures performed. I was convinced that if we stayed with a fee-for-service model we would eventually bankrupt the state.
Our Medicaid program has been in place for about 50 years, and during that time our health statistics haven't improved significantly. It was time to make a drastic change. We did it very quickly and it's working for us because for the first time we are emphasizing wellness and prevention, educating our population how to manage their diabetes and their heart conditions. We are teaching people how to stay out of the emergency room and out of the hospital.
It is causing our hospitals to revise their business plans and move away from financial reliance on emergency rooms and inpatient days. The fact that many of them are doing so well because they are getting paid for the first time for care that they used to deliver free of charge is going to help them as they change that business model.
MH: Kentucky Sen. Mitch McConnell made recent comments drawing a distinction between the success of Kynect and the Affordable Care Act. He said Kentucky could have a private exchange for insurance without all the Obamacare mandates and requirements. Do you agree?
Beshear: Quite honestly, that's political claptrap. Kynect will not exist if the Affordable Care Act is repealed. If Sen. McConnell has his way and repeals the law, he is going to take affordable insurance away from 521,000 Kentuckians. You can't have it both ways. You can't be for Kynect and against the Affordable Care Act.
A recent study found that Kentucky's Medicaid expansion will mean that 26,000 more people will get cholesterol screenings each year, 7,000 more women will get a mammogram, 10,000 more women will get a Pap smear, and 14,000 people will get treatment for depression. This is not about politics. This is making Kentuckians healthier.